社区卫生服务企业标准系统评价应用研究:以大肠癌筛查为例

Application Research on Systematic Evaluation of Enterprise Standards for Community Health Services:Taking the Colorectal Cancer Screening as an Example

背景在开展社区卫生服务综合标准化建设过程中,针对企业标准的系统评价是保障综合标准体系规范、有效、完整的前提与基础。如何对企业标准开展即期评价和远期评价?评价结果如何影响综合标准化建设?是需要解决的关键问题,但相关研究报道较少。目的以大肠癌筛查为例,对社区卫生服务企业标准进行系统评价,为同行开展企业标准评价提供参考。方法于2015年7—12月,分别组织相关评审专家对大肠癌筛查的企业标准进行文本规范性、实践契合性、系统完备性等的即期评价。于2016年1—4月,收集上海市闵行区古美社区卫生服务中心2013—2015年的社区大肠癌筛查服务量和服务成本数据,借助系统动力学方法,实现对大肠癌筛查企业标准的远期评价。结果即期评价结果显示,居民大肠癌社区筛查服务规范所描述的内容基本与实际相符,语言表述规范。远期评价结果显示,根据该企业标准开展大肠癌筛查,参与健康教育人数、参加危险度问卷评估人数、危险度问卷评估阳性人数、两次粪便隐血试验(FOBT)参与人数、癌前期病变人数、癌症人数呈现逐年下降趋势,FOBT阳性人数、综合阳性人数、肠镜检查人数呈现出先升后降趋势,至2025年可以完成对古美街道40岁及以上居民的一轮筛查。服务成本预测结果显示,古美社区卫生服务中心平均每年在大肠癌筛查方面的社区投入在12万元左右,且社区投入随着每年筛查服务人数的下降呈下降趋势,筛查完一轮的累计社区投入约为1638205.19元。结论大肠癌筛查企业标准虽符合实践但也提示筛查体系存在漏洞,由于远期评价所采用的系统动力学方法应用效力受限于信息系统的完备性,更精确的远期评价还有待信息系统完善后进一步改进。

Background In the process of building the comprehensive standardization for community health services,a systematic evaluation of enterprise standards is the prerequisite and basis for ensuring that the comprehensive standard system is standardized,effective and complete.How to conduct immediate and long-term evaluation of enterprise standards?How does the evaluation result affect the comprehensive standardization construction?These are two key problems that need to be resolved,but there are few related studies.Objective Taking the colorectal cancer screening as an example,a systematic evaluation of enterprise standards for community health services was conducted to provide a reference for peers to carry out enterprise standard evaluation.Methods From July to December in 2015,relevant experts were organized to conduct the immediate evaluation of text standardization,practice compatibility and system completeness for colorectal cancer screening.From January to April in 2016,the data on the number and cost of colorectal cancer screening services in Gumei Community Health Service Center from 2013 to 2015 were collected.The long-term evaluation of enterprise standards for colorectal cancer screening was completed with the help of system dynamics method.Results The immediate evaluation results showed that the content described in the Regulations for Community Colorectal Cancer Screening was basically consistent with practice and the language expression was standardized.The long-term evaluation results showed that the number of participants in health education,the number of participants in risk questionnaire assessment,the number of participants in risk questionnaire assessment with positive results,the number of participants in two fecal occult blood tests(FOBT),the number of patients with precancerous lesions and the number of patients with cancer showed a trend of decline year by year.The number of participants with positive FOBT results,the number of participants with comprehensive positive results and the number of participants with enteroscopy showed an upward trend and then a downward trend.A round of colorectal cancer screening for residents aged 40 and over in Gumei Community could be completed by 2025.The prediction results of service cost showed that the average investment of the colorectal cancer screening in Gumei Community Health Service Center was about 120000 yuan annually,and the community investment decreased with the decrease of screening service each year.The cumulative community investment after the screening round was about 1638205.19 yuan.Conclusion Although the enterprise standards for colorectal cancer screening is in line with practice,they also indicate that there are loopholes in the screening system.Because the application effectiveness of the system dynamics method used in the long-term evaluation is limited by the incompleteness of the information,a more accurate long-term evaluation still needs to be further improved after the information system is improved.